(2) Renewal fee--$550 for each two-year renewal period, (5) Retired midwife reinstatement fee--$275, (7) Education course initial application fee--$150, (8) Education course site visit fee--$500. (New Section adopted effective October 1, 2016, 41 TexReg 4477). This means they are not required to be nurses. The advisory board shall provide advice and recommendations to the department on technical matters relevant to the administration of this chapter, including scope of practice and health related standards of care. Meetings. The evaluation shall be conducted by a member of the department staff and a licensed midwife within the provisional year. Arizona. You can download the entire Midwives Administrative Rules document (112kb) as an Adobe PDF file, suitable for printing. The site visit will include the following: (A) an inspection of the course's facilities; (B) a review of its teaching plan, protocols, and teaching materials; (C) a review of didactic and preceptorship instruction; (D) interviews with staff and students; and. Relay Texas-TDD: (800) 735-2989, Helping Small Business and Consumers Since 1909, For more information about obtaining a TDLR license or renewing a TDLR license that expired while serving on active duty, please go to the, Air Conditioning and Refrigeration Contractors, Hearing Instrument Fitters and Dispensers, Speech-Language Pathologists and Audiologists, download the entire Midwives Administrative Rules document, License Search, Frequently Asked Questions and Guidelines, Renew online, check license status, search for a license, or file a complaint. (20) Retired midwife--A midwife licensed in Texas who is over the age of 55 and not currently employed in a health care field. 115.122. (a) Prior to delivery, the midwife shall establish a plan with the client for continuing care of the newborn. (D) documenting the termination of care in midwifery records. 115.80. Education Course Approval. (c) Individuals enrolled as students in an approved midwifery course must possess: (1) a high school diploma or the equivalent; and. The nurse-midwife is educated and trained to provide a broad range of health care services for women and newborns. (New Section adopted effective October 1, 2016, 41 TexReg 4477). (1) Midwife Training Certification Form for Newborn Screening Specimen Collection. Scope of Nursing and Midwifery Practice Framework: definition of scope of midwifery practice. (14) Normal childbirth--The labor and vaginal delivery at or close to term (37 up to 42 weeks) of a pregnant woman whose assessment reveals no abnormality or signs or symptoms of complications. (c) The midwife shall document midwifery care in legible, complete health records. In addition, all licensing candidates must meet minimum clinical education requirements, be certified in healthcare provider CPR, and neonatal resuscitation. This plan shall: (1) include referral or transfer to a health care professional who has current pediatric knowledge; (2) include a recommendation that the client pre-arrange the timing of the first newborn visit with the health care professional; and. (E) a review of student, staff and preceptor files, to include coursework, protocols, and financial records. These programs must also meet the standards of the Board of Nurse Examiners for the State of Texas (BNE). To describe the nature and scope of nurse‐midwifery practice in Texas and to determine legislative priorities and practice barriers. • Licensed Midwife assisted births are in birth centers or homes. (C) include a minimum of 250 hours course work. Midwifery practice is the independent management of women's health care. (2) a current Cardiopulmonary Resuscitation (CPR) certificate for health care providers from the American Heart Association; an equivalent CPR certificate for the professional rescuer from the Red Cross; equivalent certification for healthcare and professional rescuer from the National Safety Council; or equivalent certification issued by any provider of CPR certification for health care providers currently accepted by the Department of State Health Services’ Office of EMS/Trauma Systems Coordination. The Association of Texas Midwives recognizes the negative impacts of bullying and harassment upon the practice and profession of midwifery in Texas. A third credential is the Certified Professional Midwife (CPM). (d) Newborn Screening Test Objection Form. 115.120. License Surrender. License Renewal. An on-site evaluation of the course shall be scheduled. Complete a midwifery education program through a Texas TDLR-approved midwifery school and then pass the North American Registry of Midwives (NARM) exam (This process also qualifies her to become a CPM). (1) Once the midwife has accepted a client, the relationship is ongoing and the midwife cannot refuse to continue to provide midwifery care to the client unless: (A) the client has no need of further care; (B) the client terminates the relationship; or. (2) The midwife may terminate care for any reason by: (A) providing a minimum of 14 days written notice, during which the midwife shall continue to provide midwifery care; (B) making an attempt to tell the client in person and in the presence of a witness of the midwife's wish to terminate care and the date that care will be terminated; (C) providing a list of alternate health care providers; and. Jurisprudence Examination. (New Section adopted effective October 1, 2016, 41 TexReg 4477). (a) The department shall develop a jurisprudence examination. (New Section adopted effective October 1, 2016, 41 TexReg 4477; new effective May 1, 2019, 44 TexReg 1849). Certified nurse-midwife (CNM) functions include: Taking a medical history, and doing a physical exam; Ordering laboratory tests and procedures; Managing therapy Many midwives focus on maternity care, i.e. The following words and terms when used in this chapter shall have the following meaning unless the context clearly indicates otherwise. A Certified Nurse Midwife is a licensed registered nurse who is approved by the Texas Board of Nursing as an advanced practice registered nurse in nurse-midwifery and who is also certified by the American College of Nurse-Midwives. The form must include a section where the facility representative signs, agreeing that the facility will do the screening. A CPM must also have a Texas license or CNM credential to practice legally in Texas. (1) The commission or executive director may deny an application for initial licensure or license renewal and may take disciplinary action against any person based upon proof of the following: (A) violation of the Act or rules adopted under the Act; (B) submission of false or misleading information to the department; (C) intemperate use of alcohol or drugs while engaged in the practice of midwifery; (D) unprofessional or dishonorable conduct that may reasonably be determined to deceive or defraud the public; (E) inability to practice midwifery with reasonable skill and safety because of illness, disability, or psychological impairment; (F) judgment by a court of competent jurisdiction that the individual is mentally impaired; (G) disciplinary action taken by another jurisdiction affecting the applicant's legal authority to practice midwifery; (H) submission of a birth or death certificate known by the individual to be false or fraudulent, or other noncompliance with Health and Safety Code, Chapter 191, or 25 Texas Administrative Code (TAC), Chapter 181 (relating to Vital Statistics); (I) noncompliance with Health and Safety Code, Chapter 244, or 25 TAC, Chapter 137 (relating to Birthing Centers); (J) failure to practice midwifery in a manner consistent with the public health and safety; (K) failure to submit midwifery records in connection with the investigation of a complaint; (L) a lack of personal or professional character in the practice of midwifery; (M) failure to use generally accepted standards of midwifery care; (N) failure to exercise ordinary diligence in the provision of midwifery care; (O) failure to act competently in the provision of midwifery care; or. The ACC develops the certification exam and sets the requirements for ongoing certification. (New Section adopted effective October 1, 2016, 41 TexReg 4477). Administrative Penalties and Sanctions. (New Section adopted effective October 1, 2016, 41 TexReg 4477). Should the midwife choose to do the newborn screening she or he will obtain training to perform this test from an appropriate health care facility. (1) intrapartum oxygen may be administered to the mother for the following: (A) fetal heart rate irregularities while assessing for consultation and/or possible transfer; (C) signs or symptoms of maternal shock or hemorrhage prior to transport; (D) as indicated by American Heart Association Cardiopulmonary Resuscitation Guidelines; or. (a) Using reasonable skill and knowledge, the midwife shall: (1) provide clients with a description of the scope of midwifery services and information regarding the client's rights and responsibilities in accordance with the Act; (2) assess the client on an ongoing basis for any factors which might preclude a client from admission into or continuing in midwifery care and document that assessment in the midwifery record; (3) provide clients with information about other providers and services when requested or when the care required is not within the scope of practice of midwifery; and. (c) As long as one is available, a physician or an appropriately trained professional acting under standing delegation order from a physician at an appropriate health care facility shall instruct midwives in the proper procedure (newborn screening collection procedure of the Department of State Health Services’ Newborn Screening Program) for newborn screening blood specimen collection and submission. The disclosure statement may not exceed 500 words and must be in Spanish and English; and must contain; (3) information on where to file a complaint against a licensed midwife, including the name, mailing address and telephone number for the department. The following are grounds for denial of application for licensure or license renewal and for disciplinary action. (3) If a client elects not to accept a non-emergency transfer, the midwife shall: (B) manage the client in collaboration with a physician or another licensed health care professional who has current obstetric or pediatric knowledge and who is working under the supervision and delegation of a physician. The terms of three members expiring on January 31st of each odd-numbered year. (New Section adopted effective October 1, 2016, 41 TexReg 4477; amended effective May 1, 2019, 44 TexReg 1849). (3) be documented in the midwifery record. (4) A nonrefundable site visit fee shall be assessed for each site visit. The midwife shall: (1) maintain records that completely and accurately document the client's history, physical exam, laboratory test results, antepartum visits, consultations, referrals, labor, delivery, postpartum visits, and neonatal evaluations at the time midwifery services are delivered and when reports are received; (2) review problems identified by the midwife or by other professionals or consumers in the community; and. (b) A midwife's initial license shall be valid from the date issued until March 1 of the following renewal period. Advisory Board Membership. (2) Advisory Board--The Midwives Advisory Board appointed by the presiding officer of the Commission with the approval of the Commission. Practice Settings: CNMs work in a wide variety of settings such as clinics, hospitals, Administration of Oxygen. (c) The midwife shall assist only in normal, spontaneous vaginal deliveries as allowed by the Act or this chapter. (c) The applicant must successfully pass a criminal history background check. Definitions. Instruction will be based upon the procedure for newborn screening developed by the Department of State Health Service's Newborn Screening Program under authority of the Health and Safety Code, Chapter 33. They also provide normal newborn care for up to six weeks of age. • In Texas, Medicaid recognizes CNMs as primary care providers for women. (b) The midwife shall monitor the client's progress in labor by monitoring vital signs, contractions, fetal heart tones, cervical dilation, effacement, station, presentation, membrane status, input/output and subjective status as indicated. (New Section adopted effective October 1, 2016, 41 TexReg 4477; amended effective May 1, 2019, 44 TexReg 1849). Practice guidelines are the specific protocols of practice followed by a midwife, and they should reflect the Midwifery Model of Care. Prenatal Care. (2) use universal precautions for infection control. (4) be supervised and conducted by a course supervisor/administrator who shall: (A) be responsible for all aspects of the course; and, (B) have two years of experience in the independent practice of midwifery, nurse-midwifery or obstetrics; and, (C) have been primary care giver for at least 75 births including provision of prenatal, intrapartum, and postpartum care; and, (D) have met initial licensure requirements; or, (E) be a Certified Professional Midwife (CPM); or, (F) be American College of Nurse Midwives (ACNM) certified; or. (21) Standing delegation orders--Written instructions, orders, rules, regulations or procedures prepared by a physician and designated for a patient population, and delineating under what set of conditions and circumstances actions should be instituted, as described in the rules of the Texas Medical Board in Chapter 193 (relating to Standing Delegation Orders) and §115.111 of this title (relating to Coordinating Care with Other Health Care Providers). Initial Application for Licensure. PO Box 12157 Newborn Care During the First Six Weeks After Birth. 115.1. (3) any other prohibited practice as delineated by the Act, §203.401 (relating to Prohibited Practices). See the Texas Midwifery School website. The midwife shall not provide any further care after the arrival of emergency medical service (EMS) personnel but may do so if requested by EMS personnel. (B) to the mother and/or newborn in other situations not listed above and deemed necessary according to generally accepted standards of midwifery practice to protect the health and well-being of the mother and/or newborn; (3) indications for administration of oxygen shall be clearly documented in the midwifery record. Obtain Complaint Information without Consent of Client. 115.113. 16 Texas Administrative Code, Chapter 115 (Effective August 1, 2020). Bus. (P) a material misrepresentation knowingly made to the department on any matter or to a client during the provision of midwifery care. 115.117. (b) If a vacancy occurs on the board, the presiding officer of the commission, with the commission’s approval, shall appoint a replacement who meets the qualifications for the vacant position to serve for the remainder of the term. Background: Across the globe, midwives are the largest group of maternity care providers despite little known about midwifery practice. (3) observe the newborn for a minimum of two hours after he or she is stable with no signs of distress. 115.13. • The BNE requires CNMs to follow the Standards of Practice of Nurse-Midwifery created by the ACNM. (6) "Midwife" means a person who practices midwifery and has met the licensing requirements established by this chapter and commission rules. (New Section adopted effective October 1, 2016, 41 TexReg 4477; amended effective May 1, 2019, 44 TexReg 1849). (16) Postpartum care--The care of a woman for the first six weeks after the woman has given birth. Applications for late license renewal must include the following: (1) each of the items required for timely renewal; and, 115.16. scope of practice. (d) The midwife shall not engage in the following: (1) application of fundal pressure on abdomen or uterus during first or second stage of labor; (2) administration of oxytocin, ergot, or prostaglandins prior to or during first or second stage of labor; or. Standards for the Practice of Midwifery in Texas. Licensed midwives are midwives that have met all the requirements set forth by the state of Texas. (b) Mandatory basic midwifery education shall: (1) be offered to ensure that only trained individuals practice midwifery in Texas; (2) be offered by any individual or organization meeting the requirements for course approval established by this subsection; (3) include a didactic component which shall: (A) be based upon and completely cover the most current Core Competencies and Standards of Practice of the Midwives Alliance of North America (MANA) and the current Texas Midwifery Basic Information Manual; (B) prepare the student to apply for certification by North American Registry of Midwives (NARM); and. Midwifery in Texas: Safety, Regulation and Need, Find Local Represenative & State Legislators. Ongoing continuing education is a requirement for re-licensure every two years. A midwife’s scope of practice may change depending on the nature of their roles and the learning they have undertaken. (d) The midwife shall engage in a periodic process of evaluation and quality assurance. Standards, values, and ethics are more general than practice guidelines, and they reflect the philosophy of the midwife. (D) shall provide reasonable access for non-English speakers and comply with federal and state laws on accessibility. (5) any other abnormal newborn behavior or appearance which could adversely affect the newborn, as assessed by a midwife exercising reasonable skill and knowledge. Informed Choice and Disclosure Statement. (2) advertise or represent that the midwife is a physician or a graduate of a medical school unless the midwife is licensed to practice medicine by the Texas Medical Board; (3) use advertising or an identification statement that is false, misleading, or deceptive; or There are two types of midwives who may legally practice in the state of Texas: Certified Nurse Midwives (CNM) and Licensed Midwives (LM). (7) Commission--The Texas Commission of Licensing and Regulation. The license to practice midwifery authorizes the holder, under the supervision of a licensed physician and surgeon, to attend cases of normal childbirth and to provide prenatal, intrapartum, and postpartum care, including family-planning care, for the mother, and immediate care for the newborn. At the completion of the instruction for newborn screening blood collection, the midwife will request that the form Midwife Training Certification Form for Newborn Screening Specimen Collection be signed by the designated representative of the health care facility, attesting to the fact that the midwife has complied with this requirement. The majority of these midwives are Licensed Midwives, and some are Certified Nurse Midwives. care for pregnancy, labor & birth. The Texas Midwifery Board creates Standards of Practice for Licensed Midwives. For more information about Midwives, contact customer service. (New Section adopted effective October 1, 2016, 41 TexReg 4477). (New Section adopted effective October 1, 2016, 41 TexReg 4477). The presiding officer of the advisory board may vote on any matter before the advisory board. (23) Voluntary charity care--Midwifery care provided without compensation and with no expectation of compensation. Basic Midwifery Education. (d) If on any newborn assessment in the immediate postpartum period (first six hours of life), one of the following conditions exists, the midwife shall initiate immediate transfer to an appropriate health care professional, initiate emergency care as indicated by the situation, continue care as needed, and document that action in the midwifery record: (2) non-transient pallor or central cyanosis; (4) apgar at 5 minutes less than or equal to 6; (9) major congenital anomaly not diagnosed prenatally; (16) other abnormal newborn behavior or appearance which could threaten the life of the newborn, as assessed by a midwife exercising reasonable skill and knowledge. Coordinating Care with Other Health Care Providers. (C) the midwife formally terminates the relationship. (c) The administration and possession of prophylaxis by a midwife is not a violation of the provisions of the Health and Safety Code, Chapter 483, concerning dangerous drugs. (New Section adopted effective October 1, 2016, 41 TexReg 4477). Standards for the Practice of Midwifery in Texas (a) Using reasonable skill and knowledge, the midwife shall: (1) provide clients with a description of the scope of midwifery services and information regarding the client's rights and responsibilities in accordance with the Act; (3) The commission or executive director may revoke course approval if: (A) the course no longer meets one or more of the standards established by this subsection; (B) the course supervisor, instructor(s), or preceptor(s) do not have the qualifications required by this subsection; (C) course approval was obtained by fraud or deceit; (D) the course supervisor falsified course registration, attendance, completion and/or other records; or. (c) If on initial or subsequent assessment, one of the following conditions exists, the midwife shall recommend transfer in accordance and document that recommendation in the midwifery record: (1) placenta previa in the third trimester; (2) Human Immunodeficiency Virus (HIV) positive or Acquired Immunodeficiency Syndrome (AIDS); (3) cardio vascular disease, including hypertension, with the exception of varicosities; (5) history of cervical incompetence with surgical therapy; (7) Rh or other blood group isoimmunization; (8) previous uterine surgery involving incision into the uterine myometrium, other than a low transverse cesarean section; (10) documented oligo-hydramnios or poly-hydramnios; (11) any known fetal malformation requiring immediate post-natal hospital care; (12) Preterm Premature Rupture of Membranes (PPROM); (15) triplet or higher order multiple gestation; (16) active cancer or history of ovarian, breast, uterine, or cervical cancer; (17) undiagnosed vaginal bleeding lasting longer than two weeks; or. (a) Members of the advisory board serve staggered six-year terms. CNM educational programs are accredited by the American College of Nurse-Midwives (ACNM) and recognized by the U.S. Department of Education. (5) any other condition or symptom which could threaten the life of the mother, as assessed by a midwife exercising reasonable skill and knowledge. Late license renewal. (New Section adopted effective October 1, 2016, 41 TexReg 4477). Terms; Vacancies. (1) collect, assess and document newborn care data by monitoring the vital signs, performing a physical exam, and obtaining the laboratory tests necessary for the infant during the postpartum period; (2) provide appropriate education and counseling to the mother; and. 115.20. Renewal for Retired Midwives Performing Charity Work. Licensed Midwives work in a variety of settings such as clinics, midwifery offices, and their own private practices. 115.100. (10) Dishonored/returned check or payment fee is the fee prescribed under §60.82 of this title (relating to Dishonored Payment Device). (New Section adopted effective October 1, 2016, 41 TexReg 4477). (New Section adopted effective October 1, 2016, 41 TexReg 4477; amended effective May 1, 2019, 44 TexReg 1849). (a) Using reasonable skill and knowledge, the midwife shall collect, assess, and document maternal care data through a detailed obstetric, gynecologic, medical, social, and family history and a complete prenatal physical exam and appropriate laboratory testing, including antenatal testing if necessary; develop and implement a plan of care; thereafter evaluate the client's condition on an ongoing basis; and modify the plan of care as necessary. (3) receive approval from the department prior to returning to active practice. Administrative Rules (New Section adopted effective October 1, 2016, 41 TexReg 4477). Each BCCNM designation has its own set of Standards of Practice. (6) The department shall evaluate the application and all other pertinent information, including any complaints received and the site visit report. Certified Nurse-Midwives (CNMs) are health care providers who care for women of all ages and stages of life. (a) Each midwife who assists at the birth of a child is responsible for performing the newborn screening tests according to the Health and Safety Code, Chapters 33 and 34, and 25 TAC §§37.51 - 37.65, or making a referral in accordance with this subsection. (d) Course changes. (8) Consultation--The process by which a midwife, who maintains responsibility for the woman's care, seeks the advice of a physician or another licensed health care professional or member of the health care team of a different profession. Enforcement Authority. The midwife in attendance at childbirth shall ensure that the administration of eye prophylaxis, or the objection of the parent, managing conservator, or guardian, is entered into the medical record of the child. Transfer of Care in an Emergency Situation. 115.119. (New Section adopted effective October 1, 2016, 41 TexReg 4477). The Code requires midwives not to practise outside of their skills, knowledge or competence. (c) A quorum of the advisory board is necessary to conduct official business. Coordinating Care with Other Health Care Providers. (New Section adopted effective October 1, 2016, 41 TexReg 4477). CNMs are registered nurses that have completed a graduate-level program in nurse-midwifery. (a) The presiding officer of the commission shall designate a member of the advisory board as the presiding officer of the advisory board to serve for a term of one year. Although direct-entry midwives still practice in the U.S. today, they comprise a small fraction of practicing midwives when compared to CNMs. (D) equivalent certification issued by any provider of CPR certification for health care providers currently accepted by the Department of State Health Services' Office of EMS/Trauma Systems Coordination; (6) proof of passing the jurisprudence examination approved by the department in the four years preceding renewal. 115.123. and pass a course covering the Midwifery Basic Information and Instructor Manual. A basic midwifery education course which is currently accredited by the Midwifery Education Accreditation Council (MEAC) shall be deemed approved under this subsection upon submission of evidence of such accreditation. Independent practice is not defined by the place of employment, the employer-employee relationship, requirements for physician co-signature, of the method of reimbursement for services. I will work within the scope of practice as set forth by the Texas Midwifery Board to bring you the highest standard of care in a safe and respectful manner. Obtain Complaint Information without Consent of Client. (G) be a licensed physician in Texas actively engaged in the practice of obstetrics. Eye Prophylaxis. The department shall obtain all relevant midwifery records and medical records necessary to conduct an investigation of a complaint without the necessity of consent of the midwife’s client. • Licensed Midwives must practice according to rules and standards of care as stated in the Texas Midwifery Rules, approved by the TDLR. (2) a disclosure statement, which includes the legal requirements of the midwife and prohibited acts as stated in the Act. (a) A license issued by the department is the property of the department and shall be surrendered on demand. Be Certified by the North American Registry of Midwives (Certified Professional Midwife or C.P.M.) Health education/counseling shall be provided by the midwife as appropriate. (New Section adopted effective October 1, 2016, 41 TexReg 4477; amended effective May 1, 2019, 44 TexReg 1849). • Certified Nurse-Midwives are regulated by the BNE. The physician, registered nurse, or any other person who instructs a midwife in the approved techniques for newborn screening on the orders of a physician is immune from liability arising out of the failure or refusal of a midwife to: (1) collect and submit the blood specimen in an approved manner; or.
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